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 Table of Contents  
ORIGINAL RESEARCH
Year : 2020  |  Volume : 4  |  Issue : 2  |  Page : 168-170

Measurement of Aortic Root Dimensions by Transthoracic Echocardiogram in Normal Indian Population


Department of Cardiology, Institute of Cardiology, RGGGH, Chennai, Tamil Nadu, India

Date of Submission26-Jan-2020
Date of Acceptance29-Mar-2020
Date of Web Publication19-Aug-2020

Correspondence Address:
Dr. Deepak Nenwani
Department of Cardiology, Institute of Cardiology, RGGGH, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiae.jiae_7_20

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  Abstract 

Background: Aortic root dimension varies on the basis of age, body surface area, ethnicity, and in pathological states such as bicuspid aortic valve and connective tissue disorders. Aim: This observational study has been done to determine aortic root dimension in normal Indian population. In this study, aortic root dimensions were measured by two-dimensional (2D) echocardiography in parasternal long axis (PLAX) view by inner edge to inner edge method. Materials and Methods: Clinically normal Indian population was prospectively recruited. All participants were asymptomatic. All echocardiographic measurements were done twice and image acquired by single observer on the same machine. Aortic root dimensions measurements were done with 2D echo in PLAX view at 4-level aortic annulus, sinus of Valsalva, sinotubular junction, and proximal ascending aorta. Results: Aortic annulus does not show any significant correlation with age. Age parameter shows a significant correlation with the ascending aorta and sinus, sino-tubular (ST) junction. Weight parameter shows a significant correlation with annulus, sinus, and ST junction. Height parameter shows a significant correlation with all aortic dimensions. Conclusion: Indian patient has different body surface area than the Western population; therefore, there is a need of standard normal aortogram dimension for normal Indian population.

Keywords: Aortic root dimension, inner edge to inner edge measurement, normal Indian population


How to cite this article:
Venkatesan S, Kumar G P, Nenwani D, Swaminathan N, Shankar G R, Paul G J. Measurement of Aortic Root Dimensions by Transthoracic Echocardiogram in Normal Indian Population. J Indian Acad Echocardiogr Cardiovasc Imaging 2020;4:168-70

How to cite this URL:
Venkatesan S, Kumar G P, Nenwani D, Swaminathan N, Shankar G R, Paul G J. Measurement of Aortic Root Dimensions by Transthoracic Echocardiogram in Normal Indian Population. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2020 [cited 2020 Oct 19];4:168-70. Available from: https://www.jiaecho.org/text.asp?2020/4/2/168/292637


  Introduction Top


Aortic dimension varies on the basis of age, body surface area, ethnicity, and in pathological states such as bicuspid aortic valve and connective tissue disorders. The relationship between increasing aortic size and the risk of spontaneous rupture or dissection has been well documented.[1],[2] As a result, accurate and reproducible assessment of aortic size is an essential part of assessment aimed at detecting progressive dilatation.[2] Aortic root dimensions are important parameters in vascular disease follow-up patients which can be easily done by transthoracic echocardiogram. Some studies have shown that aortic root dimensions are independent predictors for all causes of death.[3] This study aim is to identify standard normal measurement of aortic root dimension by easily available two-dimensional echocardiography in parasternal long axis (PLAX) view in different age group in normal Indian population.


  Methods Top


Study population

Clinically normal Indian population was prospectively recruited. All participants were asymptomatic and had no prior history of coronary artery disease, diabetes mellitus, hypertension, chronic kidney disease, smoking, connective tissue disorder, and bicuspid aortic valve. Body surface area (BSA) was computed using Dubois formula: BSA (m2) = 0.007184 × height (cm) 0.725 × weight (kg) 0.425.

Echocardiography

Transthoracic echocardiogram was performed using 3.5 MHz transducer (ALOKA) in the left lateral decubitus position. All measurements were done twice and image acquired by single observer on the same machine. Aortic root dimensions measurements were done with two-dimensional (2D) echo in PLAX view at 4-levels of aortic annulus, sinus of Valsalva, sinotubular junction, and proximal ascending aorta. Measurements were performed with inner edge to inner edge as per the 2010 American Society of Echocardiography (ASE) paediatric guidelines.[4],[5] Aortic annulus was measured at peak systole and other measurements in end diastole. Aortic annulus measurement was done inner edge to inner edge at hinge point and other measurement were taken inner edge to inner edge at sinus level, sinotubular junction, and proximal ascending aorta 2 cm above sinotubular junction. All measurements were taken perpendicular to the long axis of the aorta [Figure 1].
Figure 1: Two-dimensional plax-view echo image showing method of measurement of aortic root dimension

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Sample size – 164.

Place of study – The study was conducted at the Madras Medical College, Institute of Cardiology, Chennai, India.


  Results Top


Study consisted of 164 participants, including 83 males and 81 females (male - 50.61% and female - 49.39%). Frequency and percentage of distribution of study participants on the basis of age is shown in [Table 1].
Table 1: Distribution of the study participants based on the age group

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The mean aortic dimension (cm) determined by aforementioned guidelines were aortic annulus – 18.19 ± 1.86, Sinus of Valsalva – 28.22 ± 3.33, sinotubular junction – 23.27 ± 2.93, and ascending aorta – 24.93 ± 3.09. Aortogram parameter based on the gender is shown in [Table 2]. Men had larger mean aortic diameter than women in the entire population of the study.
Table 2: Distribution of the study participants based on aortogram parameters based on gender

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Aortic annulus does not show a significant correlation with age as shown in [Table 3] and [Table 4]. Age parameter shows a significant correlation with the ascending aorta and sinus, sino-tubular (ST) junction. Weight parameter shows a significant correlation with annulus, sinus, and ST junction. Height parameter shows a significant correlation with all aortic dimensions. BSA show a significant positive correlation with all aortic dimensions [Table 5], [Table 6], [Table 7], [Table 8].
Table 3: Correlation matrix of different parameters with aortogram parameters

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Table 4: Distribution of the study participants based on annulus values in different age groups

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Table 5: Distribution of mean annulus size on the basis of body surface area

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Table 6: Distribution of mean ascending aorta values based on body surface area

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Table 7: Distribution of mean sinus values based on body surface area

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Table 8: Distribution of mean ST junction values based on the body surface area

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  Discussion Top


This study detailed normal values of aortic dimensions measurement. The results demonstrate variable aortic root dimension according to the measured guidelines used. Currently, there is disparity in the methods of measurements of aortic dimensions. In order to communicate with other-related modalities regarding aortic dimensions, there is need for common standard method which can be applicable with least error.[6] At present, magnetic resonance imaging- and computed tomography-guided measurement of aortic dimension use inner edge to inner edge method, whereas in echocardiography, which can have many confounding factors while measuring leading edge and thickness of the aortic wall, measurement from inner edge to inner edge will be a better option. Therefore, we have tried to measure standard normal dimension for the Indian patient in relevance to 2010 ASE pediatric guideline (using an inner-inner measurement).

Age and BSA have a strong influence of aortic dimensions measurement; however, association is different for different dimensions. Therefore, physicians should consider not only measurement method used but also look for different decades of age, height, BSA, gender when assessing aortic root dimension and their changes during follow-up patients.


  Conclusion of Study Top


  • Indian patient has different BSA than the Western population; therefore, there is a need of standard normal aortogram dimension for normal Indian population
  • Aortic dimension can be followed up by easily available technique of 2D echo without exposure to radiation
  • To convey the information regarding aortic dimension (whether measurement taken by leading edge to leading/outer edge to outer/leading edge to inner edge); there should be single standard method of measurement
  • Inner edge-to-inner edge method of measurement has advantage even in patient with poor-echo window.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Martín M, Lorca R, Rozado J, Alvarez-Cabo R, Calvo J, Pascual I, et al. Bicuspid aortic valve syndrome: A multidisciplinary approach for a complex entity. J Thorac Dis 2017;9:S454-64.  Back to cited text no. 1
    
2.
Roman MJ, Rosen SE, Kramer-Fox R, Devereux RB. Prognostic significance of the pattern of aortic root dilation in the Marfan syndrome. J Am Coll Cardiol 1993;22:1470-6.  Back to cited text no. 2
    
3.
Lai CL, Chien KL, Hsu HC, Su TC, Chen MF, Lee YT. Aortic root dimension as an independent predictor for all-cause death in adults 65 years of age (from the Chin-Shan Community Cardiovascular Cohort Study). Echocardiography 2010;27:487-95.  Back to cited text no. 3
    
4.
Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr., et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010;121:e266-369.  Back to cited text no. 4
    
5.
Lopez L, Colan SD, Frommelt PC, Ensing GJ, Kendall K, Younoszai AK, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: A report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 2010;23:465-95.  Back to cited text no. 5
    
6.
Flachskampf FA. How exactly do you measure that aorta? Lessons from multimodality imaging. JACC Cardiovasc Imaging 2016;9:227-9.  Back to cited text no. 6
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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Abstract
Introduction
Methods
Results
Discussion
Conclusion of Study
References
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